Determination of predictors of adverse disease outcome in patients with COVID-19 based on hemostasis system analysis

Introduction. Severe complications of the novel coronavirus infection (COVID-19) include arterial or venous thromboses, which not only complicate the disease course but also increase mortality. The development of hypercoagulability, which precedes the occurrence of thrombosis, is associated with a significant activation of the hemostasis system, as well as the appearance of microparticles in circulation. These microparticles, generated by activated blood cells, enhance the procoagulant orientation of hemostasis. In this regard, assessment of the prognostic value of changes in hemostasis system parameters associated with the progression and outcome of COVID-19 represents a relevant research task.

Objective. To identify predictors of adverse outcomes of the novel coronavirus infection based on the assessment of parameters characterizing the state of the hemostasis system.

Materials and methods. A total of 163 patients (78 males and 85 females, aged 35–90 years, median age 69 years) were examined during the acute phase of the disease with severe and moderate severity. Depending on the disease outcome, the patients were divided into two groups: the group of survivors (n = 120) and the group of the deceased (n = 43). A study of plasma hemostasis parameters was conducted, including Quick’s prothrombin test, fibrinogen concentration, activated partial thromboplastin time, factor VIII activity, ristocetin cofactor activity, von Willebrand factor content, protein C activity, antithrombin, and free protein S. In addition, the characteristics of microparticles were studied. Statistical processing of the results was performed using the Statistica 12.0 software package.

Results. In patients with adverse disease outcomes, a significant decrease in Quick’s prothrombin time (PT) and antithrombin activity was observed, along with an increase in von Willebrand factor activity, D-dimer concentration, and platelet microparticle count. The analysis of sensitivity and specificity of these parameters allowed Quick’s PT less than 70% (sensitivity and specificity were 70% and 74.3%, respectively), D-dimer level more than 800 ng/ml (sensitivity and specificity – 72% and 75.2%, respectively), and platelet MP count more than 3.22% (sensitivity and specificity – 77.8% and 72.7%, respectively) to be considered as threshold values associated with lethal outcome from COVID-19.

Conclusions. Based on the conducted ROC analysis, predictive models for the risk of adverse outcomes of COVID-19 associated with changes in hemostasis system parameters were obtained. The parameters of D-dimer concentration, Quick’s prothrombin time, and platelet microparticle count can be used as laboratory predictors of unfavorable disease progression.

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